Doctors' Somber Oath: 'First, Do No Harm'

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June 1, 1997|By Bob Brooks Special To The Sentinel

Our state and country are facing a potential milestone in medicine. The Florida Supreme Court soon will rule in the case of a man with AIDS who wants the right to have his doctor help him commit suicide.

It is my opinion that this decision - and the one still forthcoming from the U.S. Supreme Court - will be paramount in the way we in America view life and the doctor-patient relationship. I also think that the final decisions will have a broader impact on our society than the Roe vs. Wade decision on abortion in 1973, and for many reasons.

On the surface, the history of the ''right to die'' argument appears to be based on compassion and reason. Proponents say individuals should be allowed to die with dignity and without prolonged, exasperating measures being taken to keep them alive. Furthermore, the argument goes, ill people should have the right to die with the least amount of pain possible.

These are all arguments most Americans - and most doctors - agree with and encourage.

The problem comes in when doctors are asked to help patients die actively. The doctor-patient relationship - traditionally based on the concept of the doctor as the patient's advocate - becomes one of a perceived ''partnership'' in planning the death of the patient.

The fact that the patient presenting his case before the Supreme Court happens to have acquired immune deficiency syndrome plays upon emotions from prejudice to ignorance and fear. But these should not be the factors used in deciding whether someone should live or die.

Because I am a physician specializing in infectious diseases - many of which can be fatal - my first responsibility is to try to heal my patient. I use all available medicines and research to treat my patients as effectively as possible. My second responsibility, if a cure is not available, is to try to give my patient the highest quality of life possible. The key word in that sentence is life.

It is important to point out that the diagnosis of AIDS is not the death sentence it was just five years ago. I have patients who, with recent discoveries in medicine and treatments, are living very productive, almost normal lives, and it is expected that the prognosis for this disease will continue to improve. I think AIDS is subject to being targeted because of its social stigma. But the question becomes: Where do you draw the line?

One of the scariest aspects in the argument for physician-assisted suicide is the role ''managed care'' plays in the United States. With health-care spending at more than $1 trillion last year alone, our society is moving (if not being driven) very quickly to managed care to control costs. In managed care, doctors are urged to cut costs and curtail treatments unless results can be shown and the company can earn a profit.

This may seem reasonable on the surface, but it can be dangerous. For the first time ever, a doctor is asked to decide if a patient is ''worth'' treatment or if the money is better spent elsewhere. Doctors could be asked to assist in someone's death for economic rather than medical reasons.

Holland has already legalized doctor-assisted suicide. But a recent study found that nearly 15 percent of those ''euthanized'' did not give proper consent or fulfill the criteria outlined when the law was passed.

In our litigious society, do we really wish to open the floodgates of lawsuits by giving doctors the authority to decide who lives or dies? As a physician, I prefer to keep my mind focused on doing what I can to help save patients and improving their quality of life, not in deciding if they have a life worth being lived.

To serve as judge of whether a life is worth saving - in my opinion and in that of many other doctors - places too much power into the hands of people who are not God.

Something else to think about is situational ethics. Without a belief in a higher purpose for life, it becomes quite easy to ''pull the plug'' on those who don't have the same quality of life as others. This is especially frightening for the elderly and the disabled.

I think this fear is very real and may explain why many groups responsible for providing care for those segments of our population oppose physician-assisted suicide. They see who could be targeted as the next area of cost savings.

Could it now be that we have replaced compassion and respect for life with the old idea of ''survival of the fittest''? Will we become a society that sacrifices our young (unborn), our old, our weak and our disabled?

I think the reason we have come to this point may be that some of those practicing medicine are perceived to be lax in showing compassion and concern for the lives of their patients.

They forget the simple things such as holding the hand of a sick person or an occasional hug for someone in pain. Interestingly, studies show that such simple acts of kindness reduce the need for pain medication.

I find it sad that some are quick to order tests and medication and spend less time talking, holding and sharing. It is sad that life has been cheapened to the point that compassion and caring have been replaced by euphemisms such as ''death with dignity'' and ''patient's right to die.''

It is also sad that health care is callously cloaked under the guise of euthanasia, instead of having the doctor serve to look after the life of his or her patient. I am reminded of the somber oath I took when I finished medical school. The words are fundamental to the role I play in practicing medicine.